Organization
EDISTO OBGYN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME B DEGEN MD (PRESIDENT)
(803) 536-9390
Entity
Organization
Contact information
Practice address
1175 COOK RD, SUITE 305, ORANGEBURG, SC 29118
(803) 536-9390
(803) 533-0911
Mailing address
1175 COOK RD, SUITE 305, ORANGEBURG, SC 29118
(803) 536-9390
(803) 533-0911
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
07054
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070540
—
SC
Enumeration date
05/23/2006
Last updated
01/09/2008
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